Monday, April 10, 2017

Ontario's euthanasia bill - no physician conscience rights.

Bill 84 is the Ontario government’s proposed legislation designed to implement Ottawa’s law on medically assisted dying.

It ignores the conscience rights of doctors like myself, who oppose euthanasia on ethical grounds and, in its current form, will decrease public access to palliative care.

In 2015, the College of Physicians and Surgeons of Ontario changed its human rights policy to say doctors who oppose euthanasia must refer their patients who want to be considered for it to another doctor to carry out.

Doctors like myself argue this provision — known as effective referral — involves us in the euthanasia process against our will.

This despite the fact the federal law encourages provincial legislation to uphold the conscience rights of doctors.

Every other jurisdiction in the world that offers euthanasia to patients — including the other Canadian provinces — protects the conscience rights of doctors.

Every major religion and even secular humanist organizations have denounced effective referrals.

The Canadian, American, and Ontario Medical Associations all say they are unnecessary.

And yet one Ontario university medical school is already screening candidates’ views on euthanasia in their interview process — a discriminatory filtering practice.

Isn’t freedom of conscience enshrined in the Canadian Charter of Rights and Freedoms?

Why pit doctors’ conscience rights and patients’ rights to treatment against each other?

The solution is simple. It is to establish a government service by which patients can initiate on their own their request to be assessed for a medically assisted death, and recognize it in Bill 84.

The irony is the Ontario government has said it intends to create such a service, but has not agreed to give this process legal recognition in Bill 84 as an alternative to effective referral.

I am one of a group of six doctors who visit palliative care patients in their homes in Scarborough.

We are all conscientious objectors, but we would have no problem giving our patients or their families considering euthanasia a central phone number or website to contact.

Last week I accepted my final palliative care patient.

I will not abandon my current patients but I will not accept new ones until I know my conscience rights as a physician are guaranteed in law.

Though we all find this work very meaningful, half of our group is considering leaving the field, a microcosm of what is to come in Ontario.

As it is, Scarborough’s palliative care system is grossly under serviced.

We reached a wait list high of 32 patients now living in their homes last month.

Imagine being told your days are numbered, you’re in severe pain, and now you’re 30 patients away from a doctor being able to take care of you in your home.

That number will multiply.

Much of this can be prevented with a simple amendment to Bill 84.

The government’s refusal to act will further compromise your already scarce right to basic palliative care at home.

Bill 84 will be voted on in the second week of April.

Let’s protect doctors’ conscience rights by removing mandatory effective referral, while providing patients with effective access to medically assisted dying, as does the rest of the world.

This government needs to remember that health care is delivered at the bedside, not at a bureaucrat’s desk, and that patients never come first when doctors are put last.

D’Souza is a family, ER and palliative care physician, a board director of Concerned Ontario Doctors and chair of OMA District 11 (Toronto)